Optimizing Surgical Management of Acute Invasive Fungal Sinusitis.

Objective: Early surgical debridement is vital for favorable outcomes in acute invasive fungal sinusitis (AIFS). Our study aimed to propose guidelines with tailored, conservative surgical procedures based on areas of involvement and evaluate their usefulness in avoiding repeated debridement. Methods: This retrospective observational study was conducted on 150 AIFS patients operated on with the proposed surgical guidelines from May to June 2021 at a tertiary care hospital. Data including demography, comorbidities, surgical procedures, revision surgery, and outcome were collected and analyzed. Results: All 150 patients underwent bilateral endoscopic sinonasal debridement. Among them, 108 patients (72%) had current or recent coronavirus disease (COVID) infection. Ninety-two patients (61.3%) required additional procedures based on disease extent. Twenty patients (15.4%) required revision debridement because of progressive or recurrent disease. Mean age of this group was 46.15 (standard deviation ±11.2) years with a strong male predominance (9:1). Seventeen had diabetes mellitus, 12 suffered from active COVID-19 infection and six had received corticosteroids. None of the 31 patients who had recovered from COVID-19 or had no comorbidities required revision surgery. Age, gender, and comorbidities were not significant predictors for revision surgery. Fourteen patients (70%) underwent second surgery within one month of primary surgery. Predominant disease locations were alveolus and palate (55% each), and in 80% the site was uninvolved at primary surgery. The most common revision procedure was inferior partial maxillectomy (60%). At follow-up, all were asymptomatic with no evidence of disease. Conclusion: The proposed surgical guidelines for AIFS allow for adequate surgical debridement with preservation of optimum functional status. Low revision surgery rates and good outcomes with minimal morbidity validate its usefulness.

Conservative Approach for Treatment of Isolated Mandibular Fractures, the Adaptations During COVID 19 Pandemic.

Background: The ongoing COVID 19 pandemic brought about a sudden disruption to the way medical services are rendered in our country. Management of maxillofacial injuries, especially isolated mandibular fractures by surgical methods, became near impossibility because of the restrictions and other concerns related to the pandemic. Methods: The individuals who suffered isolated mandibular fracture because of trauma were included, to undergo conservative treatment methods with adaptations for the pandemic. Individuals with multiple bone fractures were excluded, and the selected patients were given the choice to opt out from this treatment plan. We followed a more conservative approach with adaptations, which we have discussed in this article. Result: The fracture healing for all the patients was as expected, and none of our team members got infected with this virus from exposure to patients. Conclusion: The adaptations helped in limiting the possible exposure of patients, relatives and health care providers to the virus and addressed other pressing concerns related to this pandemic. We present the guideline that we formulated in our unit, which we used to manage the patients who reported to us with isolated mandibular fractures during the ongoing pandemic.

Palatal flap in bilateral inferior partial maxillectomy.

Maxillectomy is done for a variety of disease conditions. Reconstruction following maxillectomy is done to restore the form and function. One of the important goals that are to be achieved in reconstruction is the separation of the oral and nasal cavities. In this article, we report the use of palatal flap by preserving the descending palatine artery during bilateral inferior partial maxillectomy, for separating the nasal cavity from the oral cavity. This technique eliminates the need for an obturator or another free or local flap for this purpose.

Coronoidoplasty in TMJ ankylosis treatment.

A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a 'coronoidoplasty' after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, 'coronoidoplasty', as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.

Nature and pattern of primary teeth extractions in a tertiary care hospital setting in South India.

BACKGROUND: Many studies have been carried out on the prevalence of dental diseases in children although not much information is available regarding its outcome among Indian children. AIM: The aim of the present study was to analyze the type of primary tooth extracted and the reasons for the extraction among children attending a tertiary care hospital in the Southern part of India. MATERIALS AND METHODS: The dental records of pediatric patients who had visited the dental clinic of a tertiary care hospital located in Tamil Nadu, South India from December 2013 to November 2016 were reviewed. Patients who underwent extraction of at least one primary tooth under local or general anesthesia were included in the study. RESULTS: A total of 943 primary teeth were extracted from 447 patients over 3 years. The most commonly extracted tooth type was the first primary molar followed by the primary central incisor. Grouping by age, the most frequently extracted tooth type between 2 and 5 years was the primary central incisor, the first primary molar among the 6-9-year-old and the second primary molar among 10-15-year-old. The majority of primary teeth extractions were performed in the age group of 6-9 years. No significant gender differences were noted. The most common reason for extraction of primary teeth in children was dental caries. CONCLUSIONS: This study demonstrates a high prevalence of untimely primary teeth extractions in young children and dental caries continues to be the leading cause. It clearly reflects on the lack of infant oral health care, the inadequacy of awareness and underutilization of oral health services among children in India.